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Intra-householddynamics and dietary diversity

Insights fromSustainable Nutrition for Allin Uganda and Zambia

Sustainable Nutrition for All Technical Paper No. 3

2 3Intra-household dynamics and dietary diversity Insights from Sustainable Nutrition for All in Uganda and Zambia

SummarySNV Netherlands Development Organisation, in partnership with the Centre for Development Innovation of Wageningen UR (CDI), the Royal Tropical Institute (KIT) and supported by the Swiss Agency for Development & Cooperation Agency (SDC) implemented a new and innovative model to empower communities to reduce the causes of malnutrition. The model, Sustainable Nutrition for All (SN4A), completed its first phase in Uganda and Zambia in 2017 and is currently in its second phase. The aim of the programme is to improve dietary diversity for all household members, with a particular focus on women of reproductive age (WRA) and infants under 2 years. The long term goal is to improve nutritional outcomes. SN4A addresses four critical pillars simultaneously. It induces behavioural change by triggering an understanding of the critical factors for improved nutrition, including production, consumption, care and sanitation practices. The triggering activities facilitate communities to undertake their own appraisal of how their nutrition habits impact their lives, particularly the physical and cognitive development of their children and their

future education and employment prospects. Communities are supported to understand what they can do to improve the situation. They formulate their own solutions which are locally available i.e. increasing household agro-biodiversity, as well as market development to generate income for improved food expenditure. To ensure sustainability and scalability of the approach, SN4A works with local and district level authorities, building their capacity to plan and implement nutrition sensitive strategies. A key aspect of the programme is the intra-household dynamics. Experiences and learnings from this pillar are presented in the technical paper, “Intra-household dynamics and dietary diversity- Insights gained from Sustainable Nutrition for All in Uganda and Zambia.” This is the third technical paper from SN4A.

Recommended Citation:KIT, SNV, CDI, SDC, 2017. Intra-household dynamics and dietary diversity. Insights from Sustainable Nutrition for All in Uganda and Zambia. Technical Paper No. 3. SNV Netherlands Development Organisation, The Hague, The Netherlands*.

Although food security has been a dominant focus in rural development interventions and research, nutritional dimensions of food security, including the gendered dimensions in nutrition have received increasing attention (Malapit & Quisumbing, 2016; Ruel et al, 2017). In parallel, there has been a growth in knowledge on the inter-linkages between agriculture, nutrition and health. However, there are still many questions concerning the complex interplay of these fields and the roles that women and men respectively play in these contexts. For example, at an intra-household level, there are gaps in understanding how gendered relations mediate processes of production and consumption and how these dynamics affect the nutritional status of different members within the household (Malapit & Quisumbing, 2016).

Addressing intra-household dynamics was recognised as a cross-cutting issue in SN4A affecting the links between production and consumption. The SN4A programme in Zambia and Uganda used an intra-household dynamics lens to design, implement and monitor the programme.

This technical paper summarises key findings and lessons learnt from applying an intra-household dynamics lens to the SN4A programme in Zambia and Uganda. It aims to assist policymakers, practitioners and researchers in understanding the approaches and

tools used and to guide their investments in integrating an intra-household perspective to understand the links between food security and nutrition. This paper focuses on unpacking how intra-household dynamics shape the links between production and consumption, and uses lessons learnt from SN4A project outcomes and interventions in Phase 1 of the programme.

The paper draws on the final analysis of project outcomes from the endline survey (Herens & Pittore, 2018) and qualitative research comprising focus groups and interviews with governance staff, nutrition action groups (NAGs) and community members in both countries over 2016 and 20171. This is further supported by data from project baseline (including community mapping) and endline findings together with project visit field notes, joint reflection meetings on intra-household changes and project implementation learnings during the sense-making workshop (KIT 2015, Verdonk, 2105, KIT, 2016, KIT 2017a, KIT 2017b, KIT 2017c, Herens & Pittore, 2018). The technical paper provides a brief overview of the intra-household dynamics lens and uses this to analyse the changes in SN4A and to highlight key lessons learnt. These are used to formulate recommendations for future programme and policy design and implementation.

Introduction

A community triggering session in Uganda

1. The qualitative research took place in two phases. Uganda (November 2016, March 2016) involved Key Informant Interview (KII) with SNV project staff, Focus Group Discussions (FGDs) with NAGs in Kyenjojo, FGDs with community members, FGDs in Kasese, KII with Caritas, District and sub county reflection meeting; Zambia August 2017 involving interviews with project staff; DNCC and HUB committee members from Chinsali and Isoka; FGDs with NAGs and Community members. For each trip a semi-structured interview guide on intra household dynamics and nutrition was used.

Acknowledgements: This brief was led by the KIT Royal Tropical Institute team (Noortje Verhart, Julie Newton, Mona Dhamankar, Lisanne Oonk, and Chloe Vaast) with support from SNV and WCDI


Building on the existing evidence base: links between nutrition and gender

SN4A’s approach to addressing intra-household dynamics is based on a relational understanding of gender. Intra-household dynamics are interpreted through the following concepts: social norms and values, division of labour, access to and control over resources, and decision-making power (see Figure 1). The intra-household dynamics framework helps to understand how roles, access and decision-making between men and women influences and is also influenced by the way they produce and consume. It provides insights into men’s and women’s ability to negotiate production, access, distribution and consumption of foods (Verhart et al., 2015). This framework challenges the idea of the household as a

unitary unit, in which all individuals in the household are seen in an equal manner, where resources are shared, and decisions are made based on rational behaviour (Kabeer, 1994).

The SN4A project used an intra-household lens3 to understand gender dynamics to leverage interventions across the four pillars to address different components of women’s role along the agriculture nutrition pathways; particularly women’s intra-household decision making and resource allocation, and women’s child care and feeding, and workload to have a positive impact on household nutrition. Whilst, intra-household dynamics are a cross cutting theme

Integrating intra-household dynamics: key insights and lessons learnt

SN4A builds on an existing evidence base on the importance of gender dynamics and the role of women in leveraging the impact of nutrition sensitive approaches. There are six main pathways that conceptualise how nutrition sensitive interventions in agriculture can contribute to improved food and nutrition security (Ruel et al, 2017; Brody et al., 2014; Meeker and Haddad 2013; SPRING; 2017). These pathways between agriculture and nutrition help to understand and measure how agricultural investments address malnutrition of individual household members, with specific attention for women and children (Box 1).2

Three of the six pathways focus on the role, contributions and status of women. These recognise the role that women play in both food and nutrition, and the necessity to address that role in nutrition sensitive agricultural interventions. Even though women play a key role in care practices and also as (future) mothers, women do not always have the resources and decision making influence to perform these roles effectively. Evidence from impact

evaluations shows that nutrition interventions have often failed to address intra-household dynamics, because nutrition counselling often only involved women, and agricultural interventions only targeted men (Newton, Verhart and Bake, 2018). This reinforces roles that men and women play (or are supposed to play) in the household, without recognising that these roles are connected and that both men and women draw from the same resources to perform these tasks. It requires a change in how men and women divide the roles, resources and their time to create necessary changes.

Evidence is now slowly being generated on how families, including extended familial networks and the wider community network can be included in both nutrition as well as agricultural interventions to support positive change within the household. This requires changes in gender norms around how roles and resources are divided. Gender norms are deeply rooted in household and community structures and addressing these warrant a different lens when designing and implementing programmes.

Box 1: Six pathways between agriculture and nutrition (Source: Ruel and Alderman, 2013; Malapit and Quisumbing, 2015)

2. Nutrition-sensitive programmes focus on the inter-linkages amongst food, health and care and aim to ad-dress underlying and basic causes of under-nutrition (Ruel, 2013)

3. The concept of the “household” has been a topic of debate for many years, especially in anthropology (Fortes and Evans-Pritchard 1940; Hammel 1961; Fox 1967; Netting, Wilk, and Arnold 1984). In this paper we will consider a “household” as “a residential, commensal group related or unrelated by kinship” (Weeratunge 2012). Households are different from families, as the term ‘family’ is limited to a group related by kinship. However, in general, households are composed of family members, and it is therefore difficult to separate the two terms clearly (Quisumbing and Smith 2007:1, Moore 1988:54).

4. The Nutrition and Gender Sensitive Agriculture (NGSA) Toolkit: www.ngsatoolkit.org

Pathways between agriculture and nutrition:

1. Agriculture as a source of diverse food2. Agriculture as a source of income for food and non-food expenditure3. Agricultural policy and food prices4. Women’s roles in agriculture, decision making and resource allocation5. Maternal employment in agriculture, child care and feeding6. Women’s time and workload

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SBCC

Triggering demand

Nutrition sensitive agriculture

Norms & values

Division of labour

Production

Consumption

Access to & control over resources

Decision-making

Intra-household dynamics

Nutrition outcomes

Evidence base

Agro-biodiversity: household access to variety of crops/foods

Dietary diversity: infant dietary diversity (6 - 23

months, women of reproductive age, dietary

diversity and stunting

Figure 1: Sustainable Nutrition for All model through an intra-household lens


throughout the four pillars, in practice intra-household dynamics were primarily addressed through the SBCC approach and nutrition sensitive agriculture interventions. The four pillars were designed in a manner to re-inforce each other to realise impact. Indeed in implementation, triggering was the 1st step of the SBCC approach. Nutrition sensitive agriculture emerged as part of post triggering support. Also building capacity of local actors such as the nutrition committees at district, sub-county (only in Uganda), hubs and community level to trigger and mentor the communities directly contributed to strengthening nutrition governance.

Implementation of the intra-household lens Below, we briefly summarise how the intra-household perspective was integrated into SN4A model in practice.

Nutrition Gender Sensitive Analysis - Com-munity mapping During the baseline of the programme, a community mapping exercise was conducted, using the NGSA toolkit developed by KIT and SNV4. The community mapping supported the baseline to generate data on intra-household dynamics and an understanding of how these affected local demand, behaviour and agricultural practices. At the start of the programme, an in-depth social and resource mapping from a gender perspective was conducted (KIT, 2015). It proved a useful approach for getting local stakeholders including community members involved and understanding some of the key gender issues that needed to be addressed in the programme. An important finding was that intra-household dynamics varied across the four districts and the countries. The information from the mapping exercise, contributed towards defining the triggering focus, the SBCC messages and aspects were also used to inform the design of training manuals on agriculture and nutrition together with the all year round crop availability study.

Integrating relevant gender messages within the Social Behaviour Change Com-munication Some of the findings from the community mapping

were used to inform the SBCC strategy. Broad messages on joint decision making were promoted around ‘caring for the household’, and ‘to both be responsible parents’ (KIT, 2017c, SNV 2017). A deliberate attempt was made to target both wives and husbands in the household. Field staff were encouraged to ensure that both men and women participate in sessions on agriculture as well as nutrition counselling (SBCC), or that nutrition and agricultural training messages would be combined in the same training.

TriggeringDifferent exercises within the triggering activities were used as entry points to highlight how intra-household dynamics were linked to malnutrition. For example, during the problem tree exercise, women’s unequal decision making around key resources was highlighted as barrier.

Nutrition sensitive agricultureA gender analysis of the all year round crop study’s findings were used to make recommendations of key areas to prioritise agriculture activities. Efforts were also made to reinforce relevant issues during the training of government staff and the implications to implementation of training on NSA with both women and men members of the household. A number of key entry points were also identified for engaging children around agriculture and nutrition through the school activities. In both Zambia and Uganda, school dramas linked to the NSA activities were used as a forum to challenge gender norms around key roles and decision making in the household.

Nutrition governanceProgramme staff (SNV staff as well as District and sub-county nutrition committee members) in the field were trained and coached during programme implementation on intra-household dynamics to support the implementation of a learning framework for adaptive programming. Staff were encouraged to use the lens to make sense of monitoring data through a learning framework to understand the key changes emerging from the project and how interventions may be changing intra-household dynamics. Whilst the project had ambitions to also integrate gender into the district nutrition plans and

link this to the adaptive programming, this was not possible in Phase 1.

Challenges in implementation Outreach to men One of the main challenges faced during project implementation was reaching out to men in the communities for the nutrition activities in both Uganda and Zambia. The focus of nutrition in the project was for the most part associated with women, considering their roles within the household. Whilst there was an active effort to reach out to men within their communities, this was met with many obstacles.

The difficulty with reaching men also lies in their frequent absence during NAG household visits. NAG members from Uganda, mentioned that they found it hard to find both husband and wife home at the same time, especially when they made household visits. One NAG member and one of her households agreed to contact each other when both husband and wife would be home. In Zambia, NAG members also cited that husbands were absent during the household visits. However, during demonstrations it was said that both members of the household were often able to attend (KIT, 2017b). In fact, when they carry out these visits in Zambia, NAGs only find the wife and children present for the trainings and household visits, as often times the husbands are already working in the field. NAGs report that men are more commonly present during group sessions or gardening demonstrations compared to cooking ones (KIT, 2017b: 31).

In response, NAGs purposefully visited locations where they could find other men with mixed experiences. Others stated that they preferred group discussions and meetings in communal settings over private household visits. In fact, during a discussion with female NAGs from Chinsali (Zambia), they mentioned that due to long distance travel and the frequent absence of men during household visits, they preferred facilitating group sessions instead of one-on-one households visits (Zambia, 2017: 21, 22).

The project also made an effort to recruit equal number of female and male NAG members. It was initially felt that the male NAGs might have more success in reaching men. However, in many cases

male NAGs and Champions already played different roles within their communities, such as a Malaria Champion or a Health Centre Champion. Men who took on various roles were often occupied with other activities, making it difficult for them to engage in the SN4A project activities.

Ability of NAGs to discuss intra-household dynamics One of the biggest challenges reported by the volunteers was working on intra-household issues. In Uganda, one female NAG member mentioned that she found it difficult to talk to others about sensitive topics such as decision-making among spouses, as she did not dare talk to her own husband about this subject. She decided to ask for help from a male NAG member. Together they approached her own husband and were able to open up the discussion. Through this experience she realised that she could not tell other households to change their behaviours if she was not able to do so herself.

This raises important questions about the ability of volunteers at community level to work on these issues and how these are nested in broader issues. It also highlights the need for intense and continuous capacity building and coaching for volunteers on how to address these issues with regular follow up and monitoring to ensure no harm to themselves and the beneficiaries.

Integrating gender as well as nutrition into district nutrition plans takes time Partnering with government staff is a key strategy in the implementation of the SN4A model. The main goal of SN4A was to support main-streaming nutrition in the district plans through a multi-sectoral approach. Working with government staff to make links between gender and nutrition proved to be an area that requires more nurturing and support on an ongoing basis, particularly to integrate the sectoral plans of

One community in Uganda suggested that it would be a good idea to go to trading centres in the afternoons.

“The difficult people always stay in these drinking places. Some trainings should be held in those centres,

for such people to have a chance to also receive the messages” (KIT, 2016:13).


respective departments.

Insights on how an intra-household lens contributed to change in diet and

agrobiodiversity outcomes The endline revealed positive changes in diet for women and children, and in agro-biodiversity at the household level. The remainder of the technical paper presents a deeper analysis of how the interventions addressed different components of intra-household dynamics along relevant pathways (Box 1)5. The examples provided illustrate how different interventions address the four dimensions of intra-household dynamics (Figure 1) and in turn how intra-household dynamics influences production and consumption of diverse foods.

Improved outcomes of diet and agro-biodiversityImproved diet The end-line revealed promising improvements in diet for both children and women across the two countries, in the project period of just over two years. There was marked reduction in IDDS inadequacy (infant dietary diversity scores) for children under two compared to baseline (Uganda mean IDDS was 5.0, Zambia mean IDDS was 4.5) (Herens & Pittore, 2017). Across the four districts overall it increased from IDDS 3.3 to IDDS 4.7. Within this, the consumption of fruits and vegetables increased substantially in Uganda compared to Zambia. The dietary diversity score for mothers and care givers (WDDS) based on 24-hour recall of consumption of 10 food groups also improved significantly across all four districts, with an overall increase by 5% and slightly higher in Uganda. Whilst meat consumption for women was still low in both countries, there was a noticeable increase in the consumption of dark leafy vegetables and fruits, particularly in Uganda. This is a marked improvement from the beginning of the project.

Improved agro-biodiversity The end-line revealed a marked increase in the

diversity of agricultural production across all districts, particularly with reference to vegetables and fruits. In Zambia, there was an increase from 0.9 to 3.9 in Chinsali, and 1.3 to 4.4 in Isoka. In Uganda, there was an increased from 1.8 to 3,8 and 0.9 to 3.8 in Kyenjojo (Herens & Pittore, 2017). There was also an increase in overall household purchase of diverse foods suggesting that through the project lifecycle, households were using combined strategies to access a variety of foods. In both countries, there was a marked increase in the ownership of home gardens particularly in Zambia (Chinsali, there was an increase from 9% to 58%, 48% to 68% in Kyenjojo) which is a reflection of this practice not taking place before the project. The endline confirms that work on the home gardens continues to be perceived as a joint or shared activity, particularly in Zambia.

Agriculture nutrition pathways that were followed Agriculture as a source of diverse food for the whole family The qualitative observational studies show marked improvement in both women and men’s perceptions around the value of consuming a diverse diet linked to improved health and nutrition. This was often discussed in the context of remembering key messages from the SBCC and triggering activities. The endline also demonstrated a strong link to positive associations with consumption of diverse food and brain development and cognition.

This is a notable improvement from initial responses during the community mapping study in Uganda and Zambia where vegetables were highlighted as one of food groups lacking in the diets of the majority of

men, women and children (KIT, 2015). For example, in Uganda at the beginning of the project, vegetables were regarded as food for the poor and households aspired for other foods considered “superior” once their incomes improved. During interviews carried out in Uganda, women mentioned that their children and husbands were asking whether the vegetables would be cooked more frequently (KIT, 2017a). Children also asked about the vegetables they eat and their nutritious values, as they are sensitised on these issues at school during the school drama. Triggering was reported as an important vehicle engaging men about the value of diverse diet through the five fingers posters and the sessions that looked at the effects of malnutrition on pregnant women and their children.

Overall, the endline together with qualitative observational studies suggest that the family approach which targeted both men and women created an awareness about the importance of consuming vegetables (translating into increased demand). Moreover, together with the nutrition sensitive agriculture activities which increased the supply of vegetables at household level, this suggests there is a strong link with the positive results on improved diet and particularly the consumption of vegetables by children and women.

Gender norms around the intra-household distribution of animal source foods In spite of positive progress on vegetable consumption for all household members, both the endline and observational studies show that there remains more work to be done to address equal and/or need-based distribution of diverse foods and share of food itself within the household. From the end-line, 40% of respondents indicated men continue to get the main share of food from meals at household level which is a positive reduction from 60% at the baseline (Herens & Pittore, 2017; Verdonk, 2015). In both

5. It is important to note that the project cannot fully assess attribution as the evaluation was not designed in this way. Nevertheless, the different sources of data (endline, qualitative observational studies, reflection workshops, key informant interviews) allow us to make interpretations of possible contribution to follow up in Phase 2. Note that the discussion primarily focuses on interventions around triggering, SBCC and nutrition sensitive agriculture.

In Uganda, one man who attended the triggering sessions was left with a very strong impression, referring back to pictures of malnourished children compared to healthy children. This made him realise that his children should not be like the malnourished child in the pictures. In Uganda these changing perceptions about the consumption of vegetables are reflected by the fact that more and more dodo (Amaranth) is offered in the church which is an indication of the value it

has. (KIT, 2016: 9).


Ugandan and Zambian households, food preparation is a task assigned to women. The end-line revealed that there was no change from the baseline, where 90% of respondents across four districts reported that this remains the main task of women (Herens & Pittore, 2017). However, there were some interesting diverse responses when asked who decides what to prepare within the countries (Herens & Pittore, 2017). In Chinsali, Zambia, there was a reduction from 70% to 42% of women reporting they decide, but an increase in joint decision making from 2% to 31% suggesting that the SBCC and triggering might be promoting more discussion within households amongst men and women about what types of food should be prepared and therefore consumed. This means that the percentage of women deciding alone has gone down in favour of joint decision making on what food to buy and/or consume. In Uganda, Kasese, there was also a rise in more joint decision making from 17 to 32%. While improvement in DDS for women and children compared to the baseline might suggest that nutritious fruit and vegetables were kept for home consumption, there remained significant gaps around the consumption of animal source foods. This suggests that where animal source foods were available, intra-household dynamics might be the reason for unequal distribution of food.

In Uganda, some women attributed having their own home gardens to gaining more decision-making power when it comes to deciding what to eat in relation to vegetables. In the past women relied on their husbands to bring vegetables home, and would wait for hand-outs from men, but now they got them from their own vegetable garden. However, they reported that husbands continued to control decisions about consumption of animal source foods such as meat, fish, and eggs. Another recurrent theme was men getting larger share of meat (KIT, 2016, 2017a) often as a sign of respect from their wives who determined the size of food portions. Some Ugandan women revealed that this was because men bought the meat. In other words, providing men with larger portions of meat was seen as an encouragement for men to continue buying meat for the household. Women were also afraid that if they did not follow the custom, their husbands might leave them and go to women who

gave them more meat (KIT, 2016: 55). This highlights the fact that, in this context, women lack control over resources to buy meat, and therefore makes them dependent on their husbands.

Norms of food distribution in Uganda influence the decisions women make, even if those choices came at the expense of their children as well as their own diets. In SN4A, men were encouraged to critically look at their meat consumption and a few of them agreed to re-distribute their portions to ensure that their children got more protein. For many families it is challenging to buy meat on a regular basis, therefore the project team has also been promoting consumption of eggs, especially for children - one egg per day. Here too men’s support is crucial, as in many households men decide whether the eggs produced are to be sold or consumed and/or if eggs are to be bought on the market. In some other cases, the project team indicated that men avoid discussing food distribution within the household, knowing full well that it would mean getting less meat to eat (KIT, 2016: 35). It is also important to note that in some households men eat at separate times or places from women and children, and may not even be fully aware of the distribution of meat.

Ugandan norms related to food consumption of mukene (silver fish), a small type of protein rich fish, turned out to be helpful in finding alternative solutions for compensating children’s low consumption of animal source food. Ugandan men seldom eat mukene, hence it became easier to feed it to the children without challenging existing inequalities of food distribution.

In Zambia, prior to the project both women and men reported that men were given the largest portions of food particularly meat. After SN4A interventions, both men and women claim that there is a more equal distribution of food amongst family members. Women have reported that they eat more of a variety of foods and that the portions of food have increased for themselves and for their children. Cooking demonstrations organised by the NAGs’ along with the nutrition cards have helped to spread message of importance of diverse diets and provide guidance on

how to make healthy meals by including vegetables from the garden in porridges, specially cooked for children (KIT, 2017b: 30). In terms of food portions, one NAG mentioned that she and her husband share equal portions of a variety of foods gathered from the garden or field and make sure that they and their children eat three times a day (KIT, 2017b: 48). These foods include potatoes, tomatoes, eggplant, rice, Chinese cabbage, millet, cassava, ground nuts, pumpkins, oranges and bananas (KIT, 2017b: 26, 27, 51). In terms of animal source foods, they cook chicken, goat, beef or pork once a week as it is expensive and difficult to find (KIT, 2017b: 39, 48). One household also explained that when it comes to consuming meat, the husband and wife both sit together and make a budget to see if they can afford to buy meat for one or two meals in the week (KIT, 2017b: 53).

The results also highlight the importance of longer-time frame and value of targeting different household members to change deeply entrenched norms which impact women’s decision making around what food is prepared. It also influences their ability to benefit from new food resources in the households. Some of the factors which impact and influence the distribution of food for the whole family are based on traditional gender norms of how food is supposed to be allocated to different members within the household. Furthermore, it is evident that access to and control over resources, and decisions made by certain members influence the distribution of food for the whole family.

Women’s time, workload and impact on care practices Gender division of labour and norms about women’s expected roles could hinder ability to prepare nutritious meals and practice optimal care practices Women interviewed from both countries recurrently mentioned time constraints as one of the main challenges they face when it comes to preparing nutritious meals for their families (KIT 2017a, 2017b). Gender norms around expected roles of women and men result in women being responsible for cleaning the house, taking care of the children, working at the

farm, and preparing meals.

In the more mountainous areas in Uganda, where land is less suitable for production, people are moving their farms further away from their homes. This requires that men and women walk greater distances to reach their farms, leaving their homes in the morning only to return in the afternoon. Women often do not have the time to cook a meal for lunch. Therefore the Ugandan project team encouraged households to prepare larger and diverse meals in order to have leftovers from earlier meals for lunch. This saves women time and ensures that children will have a meal during the day even if the wife and husband are unavailable throughout the day. In Zambia, when probed about husbands sharing work load with wives, some changes were observed with reference to fetching wood, collecting water, cleaning pots, and some even washing clothes. However, there are exceptions to the rule where, when women are sick, their husbands cook and also take over women’s responsibilities.

Within the SN4A project, NAGs encouraged households to divide some of the tasks at home, in order to alleviate women’s labour burden. In Uganda men indicated that they could help with fetching water and collecting firewood (KIT, 2016: 27). They were less inclined to take on other tasks such as cooking or taking care of the children, as these activities are strongly considered as women’s responsibilities, and are socially expected of women. Similarly in Zambia, women are the ones who prepare food and take care of the children, as well as lead in other household activities such as cleaning their surroundings, assisting their husbands in the field and maintaining the vegetable gardens. NAGs claim that husbands help their wives with making the fire and cooking food when the wives are sick, pregnant or overburdened (KIT, 2017a: 40). Furthermore, with the emphasis of everyone in the family helping out with household tasks in the SBCC, there were more reports of children also assisting with food preparation and cooking (KIT, 2017a: 44). Since the SBCC, there were a few instances of husbands assisting their wives with feeding the children and contributing to the vegetables gardens that are supposed to be


maintained and kept for the household (KIT, 2017a: 54). These would be important cases to follow up as potential role models for other men in the community.

Management of home gardens seen as joint activity, yet women and men still have a clear gender division of tasks. The baseline and mapping study in both Uganda and Zambia showed that the majority of officially registered landowners in the targeted districts are men, although this did vary in Zambia where women established their own fields (KIT, 2015; Verdonk, 2015). In both countries, men are mainly involved in the production of crops for the market (cash crop production) while the production of subsistence crops (food crops) are considered the responsibility of women (KIT, 2015). The project team assumed that

there was a high probability that the vegetable gardens (around the agricultural hubs/schools) could be considered as an activity for women, which could lead to men being less interested and engaged in the project activities. As a result, the project team made explicit effort to promote the message (through the NAGs) that home gardens were a shared task6. The qualitative studies together with the endline result suggest that this message was reinforced. However, whilst the home-garden was seen as a ‘joint’ responsibility of both the women and men in the household, there were variations in who does what. In both Uganda and Zambia, generally men will set up the garden but the management and maintenance becomes the task of the whole family, and children are included in watering the gardens. Additionally, both men and women indicated that it was relatively

easy to establish home gardens and to start growing their own vegetables. In fact the land preparation can be done in one day’s work and the seeds were provided by SN4A in the first season. Many also referred to the convenience of having a home garden next to the home, as they no longer needed to travel far to harvest the vegetables for cooking.

In Uganda, both men and women responded that they saw the homegardens as a household responsibility. However, the interpretation of who does what varied. In Uganda, the joint efforts were mainly concentrated in garden preparation (e.g. clearing bushes) and planting of vegetables (KIT, 2016), which was not very different from the past. On some occasions, men and women indicated that changes did occur. Men were increasingly helping with harvesting dodo in the garden while women are cooking (KIT, 2016) and this is a task that is uncommon for men to do.

In Zambia, while both husband and wife perceive the gardens to be a household responsibility, this also means including children. It was mentioned both by NAGs and households members that children assist their mothers with the garden, specifically when it comes to watering, weeding and collecting vegetables (KIT, 2017b). Also, many NAGs highlighted the fact that, when they visited the households for individual counselling and training on the homegardens, men were frequently not present (KIT, 2017b).Therefore NAGs would teach those who were present, usually the mothers and their children only on how to maintain their garden.

Although the SBCC emphasised the importance of working together for the benefit of the household, how this works in practice does not always translate into everyone benefitting the same in terms of amount of work. Therefore, implementation needs more active engagement to unpack what is meant when families explain ‘they work together’.

Women’s intra-household decision making and resource allocationJoint responsibility of home gardens does not

always translate into joint decision making over how benefits of home gardens can be used.The endline revealed mixed results in terms of who is able to decide on whether garden produce is sold or consumed (Herens & Pittore, 2017). In Zambia, predominantly it was men who decide if it is sold or consumed (52% Chinsali, 43% Isoka).This was also the case for decisions on whether crops from production are sold or consumed are predominantly made by men, but with a tendency for more joint decision making in Uganda.

In Uganda, in terms of the yields from the home-gardens (vegetable gardens), women have decision-making power on whether to consume or sell, and what to do with the income they earn from sales. As these are usually smaller incomes, women can have relatively more control over the use of vegetables themselves aswell as any income generated. “Women have sold vegetables on the local market, and they can control that income” (KIT, 2016:11, 22).“The vegetable gardens have also helped women to decide what food will be prepared at home, because she can pick a vegetable from the garden and does not have to spend any money (KIT, 2016: 22)”

In Zambia, the situation was varied. Generally the income from sale of vegetables is so small, it is not of interest to men. Men care more about the income from cash crops which they have control over. Moreover, there is not a large market for households to sell vegetables as they are more geographically dispersed than Ugandan households. However there were some cases where women still reported they needed permission from their husbands with regards to what to plant, sell and buy. After collecting the vegetables from the garden, a wife “must sit with husband first and agree on what she will sell, afterwards she brings the money back to the home and they sit together and make a budget” (KIT, 2017b: 43). Some women divide the vegetables in two piles (to sell and to keep): the pile of vegetables that is kept is then consumed by the household; whereas women have to consult their husbands prior to selling the remaining vegetables.

6. In Uganda, the project refers to these gardens as kitchen gardens while in Zambia, the gardens are referred to as

vegetable gardens. They both refer to the gardens that were established as part of the BCC activities


A key learning during implementation is to monitor on an ongoing basis on how the produce of home gardens are being used to benefit whom in the household. If women by default end up being the main care-taker of homestead gardens, there needs to be more active engagement with men that women should also be able to decide on the benefits of the garden

Men continue to control decisions about the use of crops and livestock. The endline confirmed that larger livestock are the domain of men whilst smaller less valuable livestock items are the domain of women and there was hardly any change from baseline (Herens & Pittore, 2017; Verdonk, 2015). The exception was the care of smaller livestock and poultry where there appeared to be a shift towards more joint decision making by both women and men, from a situation when it was mainly women in the past. The DDS indicated that consumption of animal source foods was generally low, suggesting that these were not being used for home consumption. Nevertheless, this suggests this is an area to monitor in future to ensure that some of the animals that women had more control over are not taken over by men.

In Uganda, domestic animals like cows, pigs, goats and chickens belong to men and it is usually up to them to decide when to sell versus eating the

livestock themselves. Here, the control over resources is closely linked to decision-making power, which affects what food will be accessible for consumption to the households. In many Ugandan households, they indicated that men were the ones who decided to sell all the eggs rather than keep them for consumption. The project’s team made an effort to ensure discussions with male heads of households on the consequences of selling food of high nutritional value, such as eggs (KIT, 2016: 4, 10).

In Zambia, women are responsible for chickens and ducks and other livestock such as cows, pigs and goats belong to men. While the women take care of the poultry, they cannot sell or consume them without their husbands permission (KIT, 2017b). With regards to eggs, one NAG member explained that she and her husband have decided to consume an egg once a week and the rest are to be sold (KIT, 2017b). The NAGs and households mention that they do try to eat more meat, especially after NAGs’ trainings and household visits on the nutritious value of a balanced diet. However, meat is expensive and many households are only able to afford buying meat once to two times during one week (KIT, 2017b) as they mostly buy rather than consume their own (KIT, 2017b).

Men continue to control income from sale of food crops and decision making about income.

Although the end-line did not assess the extent to which nutritious food crops were kept for home consumption or investigate what the income was used for, it did gather data on who receives the income from sale of food crops. This is an important indicator of who controls benefits of the projects interventions. The endline revealed mixed results across the two countries (Herens & Pittore, 2017). In Zambia, there was an equal distribution of who controls the revenues between women and men, whilst it was more varied in Uganda with women having more control in Kyenjojo compared to Kasese. Whilst this paints a promising picture, the qualitative research showed that decision making processes are much more nuanced.

Since men make decisions on what to sell, they usually also control the income generated from this and how it is used (for example, to pay for school fees, or to buy meat). During the interviews in Uganda, NAGs mentioned alcoholism as a serious issue for many households, which is often at the expense of buying nutritious foods for the household. This is also the case in Zambia as NAGs often cited that men tend to spend money for themselves on things that do not benefit the household. On the whole, men in both Uganda and Zambia play a big role in the household when it comes to deciding what to sell and what to buy, therefore it has been crucial to ensure that the men feel engaged with the project.

Many households buy staple foods such as maize too, even when they produce maize themselves, they lack the grinding facility so they want to sell their maize quickly (risk of weevil damage) and then buy maize flour in the shop. Staples that are rich in carbohydrates are very popular in the diets of people from this region.

Through the household visits and trainings from the NAGs, husband and wife are encouraged to consult each other over what vegetables to sell, to keep and what to budget for with the income. In practice, this was one of the areas where it was most difficult to

change behaviour. In one mixed gender focus group discussion in Zambia, NAGs also highlighted the challenges with engaging men and women within households about collaborating on making budgets for the week. It was reported in the observational studies that this was because the husbands often disagree with including their wives in making decisions over income and that men felt they do not need to share this task with their wives (KIT, 2017b). However, in most cases due to the counselling and household visits from the NAGs, husbands and wives create budgets together so there is a certain transparency as to how the money is divided for the husband and how it is divided for the household (wife and children). The income that women keep is then used for children’s school fees and/or household necessities, such as cooking oil, salt, sugar, meat, soap and lotion (KIT, 2017b). However, the money earned from the vegetable gardens does not belong only to the women. Although they keep most of income for the household, the husband still keeps a share of the money.

Furthermore, as previously mentioned, men are the ones who make final decisions with regards to buying, selling and planting. In the past, men would sell most vegetables for their own earnings and not leave enough to cook a healthy meal for the household. Presently, wives sit together and consult their husbands to come up with a budget for future purchases (KIT, 2017b). The overall joint decision-making on what to sell, buy and consume, means that dominant social norms concerning gender roles, financial access and food decision-making need to be much better understood and addressed through all interventions. The situation in Zambia appears to be mixed. From other instances reported by project staff, there were observations that men are not keen on controlling the benefits from gardens, they are too small and insignificant. They leave this to the women generally as they consider gardens to be mainly for food.

“Very few households eat chicken here. A chicken can be sold for 25,000 Ugandan Shilling (approximately 7.1 USD), which can be used to buy 1 kilogram of meat for 10,000 Ugandan Shilling. The balance can be used to buy soap, paraffin, and other necessities for the home.”

“Obundu (cassava flour) is a must - everybody is eating Obundu for dinner. And lunch is cassava and matooke. And the breakfasts is maize, as now it is the main season” (KIT, 2016: 61).

(Male respondent, Kyenjojo, Uganda)


Recommendations

• Ensure routine M&E includes a component promoting regular learning and reflection on changing intra-household dynamics: It is important to encourage an environment for learning about the influence of intra-household dynamics and how it changes project outcomes throughout the duration of the project, open for reflection and adaptation. This is crucial for adaptive programming to both challenge and reconsider interventions that seemed to be a good idea in the beginning, but turn out not be as successful.

• Support capacity building of front-line staff on addressing intra-household dynamics: Phase 1 highlighted challenges around how difficult it is for staff to discuss intra-household issues, and the need to adopt different approaches to highlight these issues in relation to nutrition during household visits. This suggested the need for more sharing of experiences and learning amongst practitioners of which approaches and messages work best with front-line staff. This should be matched with sufficient time and resources to train and coach programme staff on intra-household dynamics and invite them to share their successes and their challenges. This is vital to ensure no harm is caused to practitioners and household members when discussing intra-household dynamics. This may require efforts to identify appropriate individuals as nutrition champions and spend time on building their capacity to be role models on addressing the links between gender and nutrition for others in the community.

Based on the initial findings from Phase 1, SNV and SN4A partners recommend that policymakers and governments: • Ensure that gender analysis informs the scope of nutrition programming within a given context.

At the programme design stage, it is important to conduct an in-depth gender analysis in the communities, before programme implementation. Doing this in a participatory way with community members is important to: (1) assess the context and current situation of a community in relation to the links between nutrition, gender and agriculture; (2) understand community perceptions about under-nutrition and its probable reasons; and (3) collectively think through locally appropriate solutions. This analysis can then be used to inform the extent to which a programme will adopt a gender accommodative versus gender transformative approach to nutrition programming.

• Invest in testing and piloting of what SBCC messages and implementation modalities work best with different household members to motivate positive change around deep rooted social norms Phase 1 has identified that norms around the gender division of labour and intra-household food distribution required more time and possibly different approaches suited within the project life cycle. Moving forward, priority could be given to deepening the approaches with schools to engage both young girls and boys on links between intra-house hold dynamics, and building young people’s capacities for nutrition in their communities. Efforts to enhance more joint budgeting and planning around household resources for households nutrition needs is also an important area to invest in as the project expands in the agriculture to income pathways.

• Invest in strategies to reach and motivate men: Whilst it is increasingly recognised that it is important to reach both women and men in nutrition programming, engaging men in practice is a challenge. There is much to learn from other sectors such as reproductive health and family planning which could also be used in nutrition programming to reach men. Experience shows the value of engaging support from local political leaders, such as spiritual leaders and opinion leaders who could serve as male role models and help mobilise people and disseminate core messages.

• Invest in more research and learning in nutrition programmes to better understand the gender dynamics around the agriculture nutrition pathways: It remains a challenge to link project interventions to changes in intra-household dynamics and attribute these to agriculture and nutrition outcomes. Further investment in distilling how intra-household dynamics operate along the different agriculture nutrition pathways would support the design of more effective and targeted gender transformative programming. For example, key inquiry follow up areas include - how the benefits (food, income) of home gardens are distributed within the household particularly once these become a source of income; how changes in workload affect care practices not only of mothers but other household members.


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countries. Baltimore, MD2. Herens, M. & Pittore, K. (2017) SNV Sustainable Nutrition for All: Endline Report Project Phase 1 (2015-

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4. KIT (2015) Community Mapping (Uganda and Zambia) 5. KIT (2016) Uganda field notes (Lisanne Oonk) 6. KIT (2017a) Uganda field notes (Lisanne Oonk) 7. KIT (2017b) Zambia field notes (Chloe Vaast) 8. KIT (2017c) Internal reflection with SNV team on intra-household dynamics 9. Malapit, H., & Quisumbing, A. (2016) Gendered pathways to better nutrition. Rural 21, 01/2016, 15–17. 10. Messer, E. 1997. Intra-household allocation of food and health care: current findings and understandings

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20. Verdonk, I. (2015) SN4A Baseline 21. Verhart, N.; Dhamankar, M. Danielsen, K. (2015) Bringing agriculture and nutrition together using a

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(2015) Relationship between intra-household food distribution and coexistence of dual forms of malnutrition. Nutrition Research and Practice 2015;9(2):174-179

SNV is a not-for-profit international development organisation, working in Agriculture, Energy, and Water, Sanitation & Hygiene. Founded in the Netherlands in 1965, we have built a long-term, local presence in 30 developing countries in Asia, Africa and Latin America.

Our global team of local and international advisors works with local partners to equip communities, businesses and organisations with the tools, knowledge and connecti-ons they need to increase their incomes and gain access to basic services – empowe-ring them to break the cycle of poverty and guide their own development.

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